Leveraging donor support to develop a national antimicrobial resistance policy and action plan: Ghana’s success story

Background: To mitigate the increasing trend of antimicrobial drug resistance (AMR), the Global Action Plan (GAP) on AMR was adopted at the 68th World Health Assembly in May 2015. Subsequently, member countries were encouraged to mirror the five key strategic objectives of GAP to develop their respective National Action Plans (NAPs) by 2017. Country-specific data on AMR is, however, critical for a comprehensive NAP that will inform policy and also anchor all the objectives of GAP. Systematic reviews have been suggested by some authors to generate relevant data to inform NAP development. Objectives: This article highlights Ghana’s success story in the development of its AMR policy documents and how it could further be implemented through donor support. Methods: Literature and desk review of the activities of Ghana’s National Platform on Antimicrobial Resistance leading to the development of the NAP and AMR policy was done. Results: Ghana launched its NAP together with the accompanying policy document in April 2018. Country-specific data, which guided these documents, were obtained by leveraging donor support activities through the National Platform on Antimicrobial Resistance. Conclusion: Ghana’s success story on the development of AMR policy documents is pivoted on a strong political will and the leveraging of donor support for specific activities

Quinolone resistance in Escherichia coli from Accra, Ghana

We documented for the first time the molecular basis for quinolone resistance in Ghana and the presence of horizontally disseminated genes conferring resistance to these drugs. --author-supplied descriptio

Quinolone resistance in Escherichia coli from Accra, Ghana

<p>Abstract</p> <p>Background</p> <p>Antimicrobial resistance is under-documented and commensal <it>Escherichia coli </it>can be used as indicator organisms to study the resistance in the community. We sought to determine the prevalence of resistance to broad-spectrum antimicrobials with particular focus on the quinolones, which have recently been introduced in parts of Africa, including Ghana.</p> <p>Results</p> <p>Forty (13.7%) of 293 <it>E. coli </it>isolates evaluated were nalidixic acid-resistant. Thirteen (52%) of 2006 and 2007 isolates and 10 (66.7%) of 2008 isolates were also resistant to ciprofloxacin. All but one of the quinolone-resistant isolates were resistant to three or more other antimicrobial classes. Sequencing the quinolone-resistance determining regions of <it>gyrA </it>and <it>parC</it>, which encode quinolone targets, revealed that 28 quinolone-resistant <it>E. coli </it>harboured a substitution at position 83 of the <it>gyrA </it>gene product and 20 of these isolates had other <it>gyrA </it>and/or <it>parC </it>substitutions. Horizontally-acquired quinolone-resistance genes <it>qnrB1</it>, <it>qnrB2</it>, <it>qnrS1 </it>or <it>qepA </it>were detected in 12 of the isolates. In spite of considerable overall diversity among <it>E. coli </it>from Ghana, as evaluated by multilocus sequence typing, 15 quinolone-resistant <it>E. coli </it>belonged to sequence type complex 10. Five of these isolates carried <it>qnrS1 </it>alleles.</p> <p>Conclusions</p> <p>Quinolone-resistant <it>E. coli </it>are commonly present in the faecal flora of Accra residents. The isolates have evolved resistance through multiple mechanisms and belong to very few lineages, suggesting clonal expansion. Containment strategies to limit the spread of quinolone-resistant <it>E. coli </it>need to be deployed to conserve quinolone effectiveness and promote alternatives to their use.</p

Regional Dissemination of a Trimethoprim-Resistance Gene Cassette via a Successful Transposable Element

Antimicrobial resistance is a growing international problem. We observed a 50% increase in the prevalence of trimethoprim resistance among fecal Escherichia coli from healthy Nigerian students between 1998 and 2005, a trend to increase that continued in 2009.A PCR-based screen revealed that 131 (43.1%) of isolates obtained in Nigeria in 2005 and 2009 carried integron-borne dfrA cassettes. In the case of 67 (51.1%) of these isolates, the cassette was a class 1-integron-borne dfrA7 gene, which has been reported at high prevalence from E. coli isolates from other parts of Africa. Complete sequencing of a 27 Kb dfrA7-bearing plasmid from one isolate located the dfrA7 gene within a Tn21-type transposon. The transposon also contained an IS26-derived bla/sul/str element, encoding resistance to β-lactams, sulphonamides and streptomycin, and mercury resistance genes. Although the plasmid backbone was only found in 12 (5.8%) of trimethoprim-resistant isolates, dfrA7 and other transposon-borne genes were detected in 14 (16.3%) and 32 (26.3%) of trimethoprim resistant isolates collected in Nigeria in 2005 and 2009, respectively. Additionally, 37 (19.3%) of trimethoprim-resistant E. coli isolates collected between 2006 and 2008 from Ghana were positive for the dfrA7 and a transposon marker, but only 4 (2.1%) harbored the plasmid backbone.Our data point to transposition as a principal mechanism for disseminating dfrA7 among E. coli from Nigeria and Ghana. On-going intensive use of the affordable broad-spectrum antibacterials is likely to promote selective success of a highly prevalent transposable element in West Africa

Growing Problem of Multidrug-Resistant Enteric Pathogens in Africa

A disproportionate number of low-income persons are affected

Bacteria and Their Antibiotic Resistance Profiles in Ambient Air in Accra, Ghana, February 2020: A Cross-Sectional Study

Inappropriate use of antibiotics has led to the presence of antibiotic-resistant bacteria in ambient air. There is no published information about the presence and resistance profiles of bacteria in ambient air in Ghana. We evaluated the presence and antibiotic resistance profiles of selected bacterial, environmental and meteorological characteristics and airborne bacterial counts in 12 active air quality monitoring sites (seven roadside, two industrial and three residential) in Accra in February 2020. Roadside sites had the highest median temperature, relative humidity, wind speed and PM10 concentrations, and median airborne bacterial counts in roadside sites (115,000 CFU/m3) were higher compared with industrial (35,150 CFU/m3) and residential sites (1210 CFU/m3). Bacillus species were isolated in all samples and none were antibiotic resistant. There were, however, Pseudomonas aeruginosa, Escherichia coli, Pseudomonas species, non-hemolytic Streptococci, Coliforms and Staphylococci species, of which six (50%) showed mono-resistance or multidrug resistance to four antibiotics (penicillin, ampicillin, ciprofloxacin and ceftriaxone). There was a positive correlation between PM10 concentrations and airborne bacterial counts (rs = 0.72), but no correlations were found between PM10 concentrations and the pathogenic bacteria nor their antibiotic resistance. We call for the expansion of surveillance of ambient air to other cities of Ghana to obtain nationally representative information

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest